Combining Thread Lifting and Filler Injections

Relax, refill, and reposition are the basic three R’s of pan-facial rejuvenation. As a practitioner, my three Rs are the same for my non-invasive and surgical patients: relaxing the muscle movement with toxin, refilling underlying tissue using fillers or fat to restore volume, and repositioning the superficial musculoaponeurotic system (SMAS) layer through threads or surgery to immediately lift sagging tissue and skin.¹

I perform these three modalities in combination in a specific order. First, I perform my thread lift to reposition and lift the tissue before revolumizing the temples, midface, and jawline with filler. To complete the process, I use neuromodulator to relax muscle movement and prevent future wrinkles.

Using this particular order of treatment requires using less filler when repositioning the tissues first. Additionally, when repositioning and lifting the tissue using threads first, you can clearly see where the patient still needs revolumization with the filler.

Figure 1 visualizes a patient before and 1-month-post-threads, filler, and neuromodulator. What I like about using this 3-step method is it gives a natural result. In this patient, threads were used to the midface, lower face, and neck. Filler was added to her temples, midface and jawline.

Figure 1 visualizes a patient before and 1-month-post-threads, filler, and neuromodulator.

Figure 2 shows before and after photos of a younger patient, who only had threads in the midface and lower face. Threads were not needed in the neck area because she is younger, but she wanted a slight rotation of the tip of the nose. A combination of threads and filler was used; threads provide support and filler adds a bit extra. In Figure 2, the filler was also used in the midface and jawline. Neuromodulator was used at her glabella, forehead, and crow’s feet.

Figure 2 shows before and after photos of a younger patient, who only had threads in the midface and lower face.

NEW PROCEDURE ADDED TO CLINIC

Meshfill threads with simultaneous filler and neurotoxin to lift the brows can be a quick, difference-making addition to a clinic. It easily lifts the brow using threads, filler, and neuromodulator. The advantages of this procedure are the ease and speed of the procedure and the virtual lack of downtime. Conversely, it might not provide as much of a lift as the patient desires.

The goal of meshfill with a high g’ filler is lateral brow elevation and to create and restore the much-desired oval of beauty underneath the lateral brow arch. Aside from the quickness, the filler moving is not a concern because it will stay in the tube and give the beautiful volume you are looking for (Figure 3).

Figure 3 shows aside from quickness, filler moving is not a concern because it will stay in the tube and give the beautiful volume you are looking for.

CONCLUSION

Threads are here to stay, and they are only getting better with better products and more advanced ways to use them. Patients are becoming increasingly accepting of threads and adverse to filler, but it is important to note they are two different modalities that deliver two different clinical outcomes. As practitioners, we need to stop thinking about fillers vs threads and advance the ways we can use them in combination to complement each other. pan-facial rejuvenation is not a new procedure, but working on ways to approach it differently is crucial for its advancement and growth.

1. Nestor MS, et al. J Drugs Dermatol. 2017; 16(7)661-666.

2. Lorenc ZP, et al. J Drugs Dermatol. 2018; 17(6): 647-655.